Abstract
Atlas-based analyses of patients with cardiovascular diseases have recently been explored to understand the mechanistic link between shape and pathophysiology. The construction of probabilistic atlases is based on statistical shape modeling (SSM) to assess key anatomic features for a given patient population. Such an approach is relevant to study the complex nature of the ascending thoracic aortic aneurysm (ATAA) as characterized by different patterns of aortic shapes and valve phenotypes. This study was carried out to develop an SSM of the dilated aorta with both bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV), and then assess the computational hemodynamic of virtual models obtained by the deformation of the mean template for specific shape boundaries (i.e., ±1.5 standard deviation, σ). Simulations demonstrated remarkable changes in the velocity streamlines, blood pressure, and fluid shear stress with the principal shape modes such as the aortic size (Mode 1), vessel tortuosity (Mode 2), and aortic valve morphologies (Mode 3). The atlas-based disease assessment can represent a powerful tool to reveal important insights on ATAA-derived hemodynamic, especially for aneurysms which are considered to have borderline anatomies, and thus challenging decision-making. The utilization of SSMs for creating probabilistic patient cohorts can facilitate the understanding of the heterogenous nature of the dilated ascending aorta.
Highlights
Ascending thoracic aortic aneurysm (ATAA) is a permanent dilatation of the aortic wall, with risk stratification based on the maximum aortic diameter measured by diagnostic imaging [1]
There is, a general consensus on the need for the development of new risk stratification strategies based on the aortic size, and this is a consequence of the awareness of aneurysm heterogeneity presenting different patterns of aortic dilatation and bicuspid phenotypes [5]
For the ATAA patient population here investigated, the principal component analysis (PCA) demonstrates that 90% of the overall shape variability can be captured by the first seven modes for bicuspid aortic valve (BAV)
Summary
Ascending thoracic aortic aneurysm (ATAA) is a permanent dilatation of the aortic wall, with risk stratification based on the maximum aortic diameter measured by diagnostic imaging [1]. Elective repair of ATAAs is carried out for aortic diameter ≥ 50 mm, but aggressive management in case of predisposing risk factors as the bicuspid aortic valve (BAV) and hypertension is recommended [2]. ATAAs. There is, a general consensus on the need for the development of new risk stratification strategies based on the aortic size, and this is a consequence of the awareness of aneurysm heterogeneity presenting different patterns of aortic dilatation (i.e., the aortic root phenotype, the tubular aorta, and the diffusive involvement of the aortic dilatation) and bicuspid phenotypes (i.e., the anterior–posterior cusp fusion or the right–left cusp fusion) [5]
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